Now, San Francisco is combining those firsts into yet another pioneering move by becoming the first city in the country to cover the cost of gender reassignment surgeries for its uninsured transgender residents.

The Department of Public Health has long been on the cutting-edge of providing medical care for transgender patients. It established a special clinic for them in 1994 and offers hormone therapy, counseling and primary care services.

That’s about to change thanks in large part to advocacy from the city’s Transgender Law Center and Supervisor Scott Wiener who quietly introduced legislation at the Board of Supervisors over the summer encouraging the health department to remove the exclusion from its code.

“Healthy San Francisco was discriminating against transgender people by denying them medically necessary health care,” Wiener said.

The discrimination was particularly blatant in that the department provides and covers hysterectomies for women with cancer, but not for women who choose to transition to men. Likewise, it provides and covers the removal of testicles for men with cancer, but not for men transitioning to women.

We’ll pause here for two points. One: the resolution at the board passed unanimously, demonstrating what a non-issue this is in San Francisco. Two: we’ve got to give credit to Wiener, also the proponent of a ban on public nudity, for not shying away from legislation that’ll get him teased because of his name.

The health department didn’t object to the supervisors’ move, and now the Health Commission has made it official by also passing a resolution that the surgeries be covered.

“Providing these services is quite nominal compared to the benefits that would improve this community’s health outcomes, which is pretty much priceless,” said Health Commissioner Cecilia Chung, herself a transgender woman.

She said people who feel like their inner selves don’t match their bodies’ gender are more likely to suffer serious diseases including heart disease, HIV and hepatitis. Helping them transition through surgery, if that’s what they choose, can improve their long term health outcomes and save the city money overall, she said.

The health department is now creating a new program that will cover all parts of treating transgender patients including surgeries for those who opt for them.

Private medical groups like Kaiser and California Pacific Medical Center that participate in Healthy San Francisco, the city’s universal health care plan, won’t have to provide the surgeries. Instead, their current patients who are transgender will be covered by the new program. For now, the surgeries will be contracted out to private doctors who perform them, but the health department hopes to recruit its own surgeons.

Tangerine Brigham, director of Healthy San Francisco, said that 200 Healthy San Francisco patients have told the department they are transgender, though some may not have revealed that they are.

There’s no telling how much the surgeries will cost the city because not all transgender patients are likely to want them, and those who do will range from those who may want one surgery versus those who want to change their gender from, well, top to bottom.

It may sound like one of those only-in-San-Francisco policies, but Wiener pointed out that scores of major companies including Xerox, Microsoft and PepsiCo offer employee health insurance plans that cover transgender care including surgeries. And other cities, including New York, Berkeley and Seattle cover gender reassignment surgeries for their employees.

But when it comes to providing gender reassignment surgeries for any uninsured resident who wants one, San Francisco is, as usual, at the forefront. And city officials seem unanimous in believing that’s just fine — even if it prompts eye-rolling among those who don’t live here.

“A lot of times, people roll their eyes and say, ‘Only in San Francisco,’” Wiener said. “And then 10 years later, they’re doing the same thing.”